Critical aortic stenosis. Survival and management

Area of Science:

• Pediatric Cardiology
• Congenital Heart Disease
• Cardiac Surgery

Background:

• Critical aortic stenosis is a severe congenital heart defect in neonates.
• Transventricular aortic valvotomy is a surgical option for this condition.
• Understanding factors influencing survival is crucial for improving outcomes.

Purpose of the Study:

• To review factors associated with survival in neonates undergoing transventricular aortic valvotomy for critical aortic stenosis.
• To compare outcomes between open and closed aortic valvotomy techniques.

Main Methods:

• Retrospective review of 40 neonates (age < 28 days) with critical aortic stenosis.
• Patients underwent either open (22) or closed (18) transventricular aortic valvotomy.
• Analysis of preoperative clinical, echocardiographic, and operative data correlated with survival.

Main Results:

• Adverse survival correlates included preoperative poor perfusion (low pH, murmur grade) and congestive heart failure (hepatomegaly, cardiomegaly).
• Mortality factors included congenital mitral stenosis, small aortic annulus, and inadequate aortic orifice size post-operation.
• Initial survival favored closed valvotomy, but overall operative survival (36-50%) and long-term survival (32%) showed no significant difference between techniques. Early reoperation rates were higher after closed valvotomy.

Conclusions:

• Long-term survival for critical neonatal aortic stenosis remains poor (32%) and has not improved significantly.
• Preoperative patient condition and intraoperative anatomical factors are critical determinants of mortality.
• Neither open nor closed transventricular aortic valvotomy demonstrates a significant long-term survival advantage.